海角大神

The main road through this charming Breton town separates stone cottages from a pale green marsh that leads to the sea. But in Cherrueix, neither the beach nor the picturesque farmland have been enough to attract fresh faces to live here.

After Fran莽ois Gobl茅 retired this March, the town and surrounding area of 5,000 inhabitants were left with one primary care physician. 鈥淚 was working from eight in the morning until 11 at night,鈥� says Dr. Gobl茅. 鈥淎fter 45 years as a doctor, it was impossible to continue in this way.鈥�

Cherrueix is just one example of a 鈥渕edical desert鈥� 鈥� where the number of doctors is 30 percent lower than the national average in France. This is especially a concern for elderly patients or those with reduced mobility.聽It鈥檚 also a symptom of a larger problem in France and across the globe: An increasing number of small towns are struggling economically and demographically to remain competitive in the face of urbanization. As more young people move to major city centers, the vibrancy and economic viability of small and medium-sized towns are slowly dying. Now, local leaders, grassroots efforts, and 鈧�5 billion in state aid are working to reverse the trend. 聽 聽聽

鈥淭he problem is jobs in many small towns,鈥� says Marc Ivaldi, research director at the Toulouse School of Economics. 鈥淚t鈥檚 difficult to keep doctors and other professionals in these areas, plus transport costs are going up, so people are inevitably leaving for larger cities.鈥�

Enhancing the core聽

France鈥檚 small towns have long had an image of enchanting tranquility for tourists and city dwellers alike. And while a quarter of the population live in small or medium-sized towns and many French still invest in second homes in the countryside, living full time in such areas has become increasingly less attractive.

To combat the exodus to larger cities, in March the government named 222 towns that will receive 鈧�5 billion ($5.7 billion) over the next five years 鈥� to revitalize city centers, create jobs, and improve transportation and quality of life. 聽 聽聽

Through the 鈥淗eart of the City Action鈥� plan, so far more than 500 projects across France are under way. The town of Louviers, in Normandy, has enlarged and enhanced sidewalks and offered free parking to bring more business back to the city center. The north-central city of Chartres plans to create new housing and several cultural centers.聽

Some cities got a head start with local initiatives. Saint-Malo, a popular Breton beachside hangout for Parisians looking to beat the summer heat, has been attempting to attract more young people, many of whom have been pushed out because of climbing housing prices in the city center.聽They鈥檝e begun offering tax breaks to first-time homeowners as well as putting more funding into schools and cultural events like music festivals 鈥� measures City Hall says will inevitably lure young couples. (According to INSEE, the national statistics bureau, 60- to 74-year-olds account for the largest segment of the town鈥檚 47,000 residents, and there have consistently been more recorded deaths than births from 2007 to 2016.)聽

Working against such initiatives are harsh realities 鈥� many small towns have lost industries essential to economic survival, with employers moving to larger cities to improve operating costs and find workers.

鈥淒eindustrialization in the last 40 years is definitely a major cause,鈥� says Emmanuel Martin, an independent economist based in the south of France. 鈥淢any small towns relied on one industry or factory and when it closed down, what could they do?鈥�

A knock-on effect has been the trend toward hypermarkets and commercial zones on the periphery of small towns, generating competition for small businesses in town centers. And as the state invests more into tramways and metro lines in cities, and less into roads to connect small towns with larger ones, people are finding themselves increasingly isolated.

Creating new balance聽

Maxime Lebigot is a cardiology nurse at a local hospital in Laval, a town between the Brittany region and Paris. Laval is part of the government鈥檚 Heart of the City Action plan, and has seen a consistent drop in聽population over聽last decade. Mr. Lebigot says that the hospital staff is severely overworked owing to the demands of an aging population and a lack of general practitioners.聽

鈥淭hey鈥檝e gotten rid of dozens of hospital beds and the ER is constantly clogged up,鈥� says Lebigot. After he was told his son would wait months for a doctor鈥檚 appointment, Lebigot and his wife, Elodie, headed up the Mayenne regional branch of a citizens鈥� rights group whose specific aim is to tackle the medical desert problem. 鈥淭here are enough doctors in France in terms of numbers, but they are very poorly divided up.鈥�

According to DREES, a state-run statistics body, around 8 percent of French 鈥� or 5.3 million people 鈥� lived in a medical desert in 2017, with the most affected regions in the east of the country. 聽Here in France鈥檚 northwest region of Brittany, one initiative proposes making it easier for replacement doctors to become permanent fixtures in their towns, while another in the Vend茅e region uses virtual visits with doctors to treat some patients. In many regions, doctors are coming out of retirement to deal with the lack of practitioners.

Professor Ivaldi, the economist, says that paying doctors to live in deprived areas could be one solution, but that more money must be invested into small and medium-sized towns in general to boost their vitality 鈥� instead of dealing with each symptom individually.

鈥淲e need to create more schools and public services outside big cities, and that costs more because local tax rates have increased a lot,鈥� says Ivaldi. 鈥淲e used to have more harmonized development [between small and large cities] but now it鈥檚 more expensive to maintain forests, roads, and infrastructure outside the city, plus this is being covered less and less by the state.鈥�

Mr. Martin says that 鈥� although an unpopular idea to most 鈥� adjusting the minimum wage to reflect the cost of living regionally could help balance out the divide between small and large cities, eventually making products and services cheaper in smaller towns. Right now, France鈥檚 minimum wage 鈥� at nearly 鈧�1,500 per month ($20,400 per year) 鈥� is one of the highest in the world and is the same whether you live in Paris, P茅rigueux, or Pesmes.

But Martin, who himself lives in a small town, says that the effects of urbanization are not necessarily surprising nor should they always be viewed as a negative. 鈥淧eople are leaving but isn鈥檛 it the natural, evolutionary process?鈥� he asks. 鈥淭owns have to answer the needs of the people and if they鈥檙e not able to do so, it鈥檚 part of life.鈥�